ObjectiveTo determine the effectiveness of a novel interdisciplinary treatment compared with usual care on weight loss in overweight and obese adult volunteers.DesignSingle blinded controlled trial. Participants randomly assigned to usual care (C, general guideline-based diet and exercise advice), intervention (I, interdisciplinary protocol) or intervention + a healthy food supplement (30 g walnuts/day) (IW).SettingCommunity based study, Illawarra region, south of Sydney, Australia.ParticipantsGenerally well volunteer adult residents, 25-54 years, body mass index (BMI) 25-40kg/m2 were eligible. At baseline 439 were assessed, 377 were randomised, 298 completed the 3-month intensive phase and 178 completed the 12-month follow-up.InterventionsTreatment was provided at clinic visits intensively (0 months, 1 month, 2 months, 3 months) then quarterly to 12 months. Support phone calls were quarterly. All participants underwent blinded assessments for diet, exercise and psychological status.Primary and secondary measuresThe primary outcome was difference in weight loss between baseline and 12 months (clinically relevant target 5% loss). Secondary outcomes were changes in blood pressure, fasting blood glucose and lipids, and changes in diet, exercise and psychological parameters.ResultsAt 12 months, differences in weight loss were identified (p<0.001). The I group lost more than controls at 3 months (91.11 (92.23,90.00), p<0.05) and the IW more than controls at 3 months (91.25 (92.35,90.15), p<0.05) and 6 months (92.20 (93.90,90.49), p<0.01). The proportion achieving 5% weight loss was significantly different at 3 months, 6 months and 9 months (p=0.04, p=0.03, p=0.03), due to fewer controls on target at 3 months, 6 months and 9 months and more IW participants at 6 months. Reductions in secondary outcomes (systolic blood pressure, blood glucose/lipid parameters and lifestyle measures) followed the pattern of weight loss.ConclusionsAn interdisciplinary intervention produced greater and more clinically significant and sustained weight loss compared with usual care. The intensive phase was sufficient to reach clinically relevant targets, but long-term management plans may be required.Trial registration numberANZCTRN 12614000581662; Post-results.

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Several regulatory bodies have approved a health claim on the cholesterol-lowering effects of oat b-glucan at levels of 3·0 g/d. The present study aimed to test whether 1·5 g/d b-glucan provided as ready-to-eat oat flakes was as effective in lowering cholesterol as 3·0 g/d from oats porridge. A 6-week randomised controlled trial was conducted in eighty-seven mildly hypercholesterolaemic ($5 mmol/l and ,7·5 mmol/l) men and women assigned to one of three diet arms (25 % energy (E%) protein; 45 E% carbohydrate; 30 E% fat, at energy requirements for weight maintenance): (1) minimal b-glucan (control); (2) low-dose oat b-glucan (1·5 g b-glucan; oats low -OL) or (3) higher dose oat b-glucan (3·0 g b-glucan; oats high -OH). Changes in total cholesterol and LDL-cholesterol (LDL-C) from baseline were assessed using a linear mixed model and repeated-measures ANOVA, adjusted for weight change. Total cholesterol reduced significantly in all groups (27·8 (SD 13·8) %, 27·2 (SD 12·4) % and 25·5 (SD 9·3) % in the OH, OL and control groups), as did LDL-C (28·4 (SD 18·5) %, 2 8·5 (SD 18·5) % and 25·5 (SD 12·4) % in the OH, OL and control groups), but between-group differences were not significant. In responders only (n 60), b-glucan groups had higher reductions in LDL-C (2 18·3 (SD 11·1) % and 218·1 (SD 9·2) % in the OH and OL groups) compared with controls (211·7 (SD 7·9) %; P¼ 0·044). Intakes of oat b-glucan were as effective at doses of 1·5 g/d compared with 3 g/d when provided in different food formats that delivered similar amounts of soluble b-glucan.Key words: Cholesterol: Oats: b-Glucans: Solubility: DosageThe viscous soluble fibre found in oats ((1 ! 3),(1 ! 4) b-D-glucan) has been demonstrated to have cholesterollowering effects (1,2) . However, despite the majority of trials showing a cholesterol-lowering effect in hypercholesterolaemic subjects, no clear dose-response relationship has been demonstrated.In addition, not all oat products show similar effects (3 -5) . The cholesterol-lowering properties appear to be linked to the physico-chemical properties of the soluble b-glucan fraction, rather than the total soluble fibre content per se (6) . Putative effects have been attributed to an influence on the sequestering of bile acids in the gut, reducing re-absorption and return to the liver for further synthesis (7 -9) . The direct effects of oat bran on cholesterol levels might also be better seen in the immediate postprandial period through a dramatic effect on decreased chylomicron cholesterol (10) .The cholesterol-lowering effects of b-glucan may be influenced by a number of factors, primarily the molecular weight, solubility and viscosity in the product (as consumed) and these are dependent on the food microstructure, dosage and the type of food processing that has been undertaken. For example, the process of enrichment may affect efficacy (3) . Possible unfavourable structural changes that occur to b-glucan during commercial extraction include depolymerisation of the linear structure which decreases molec...

Background/Objectives:Direct evidence for the effects of vegetable intake on weight loss is qualified. The study aimed to assess the effect of higher vegetable consumption on weight loss.Subjects/Methods:A single blind parallel controlled trial was conducted with 120 overweight adults (mean body mass index=29.98 kg/m2) randomised to two energy deficit healthy diet advice groups differing only by doubling the serving (portion) sizes of vegetables in the comparator group. Data were analysed as intention-to-treat using a linear mixed model. Spearmans rho bivariate was used to explore relationships between percentage energy from vegetables and weight loss.Results:After 12 months, the study sample lost 6.5±5.2 kg (P<0.001 time) with no difference between groups (P>0.05 interaction). Both groups increased vegetable intake and lost weight in the first 3 months, and the change in weight was significantly correlated with higher proportions of energy consumed as vegetables (rho=–0.217, P=0.024). Fasting glucose, insulin and triglyceride levels decreased (P<0.001 time) and high-density lipoprotein cholesterol levels increased (P<0.001 time), with no difference between groups. Weight loss was sustained for 12 months by both groups, but the comparator group reported greater hunger satisfaction (P=0.005).Conclusions:Advice to consume a healthy low-energy diet leads to sustained weight loss, with reductions in cardiovascular disease risk factors regardless of an emphasis on more vegetables. In the short term, consuming a higher proportion of the dietary energy as vegetables may support a greater weight loss and the dietary pattern appears sustainable.